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N. N. Patel, C. E. Song, V. Sarup, K. J. Wald; Comparison of 20-Gauge and 25-Gauge Pars Plana Vitrectomy for Treatment of Uncomplicated Diabetic Vitreous Hemorrhage. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4191.
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To compare postoperative outcomes following twenty and twenty five-gauge pars plana vitrectomy (PPV) for uncomplicated diabetic vitreous hemorrhage.
A retrospective chart review was undertaken of all patients who underwent PPV for uncomplicated diabetic vitreous hemorrhage by a single surgeon (KJW). Patients included in this study were diabetics with nonclearing vitreous hemorrhage greater than 2 months that had no prior history of retinal detachment or surgical repair. Cases with rubeosis iridis, known severe macular disease, repair involving gas or silicone oil were excluded. Detailed pre- and postoperative evaluations included best-corrected snellen visual acuity, Goldmann applanation tonometry and fundoscopy. Special note was taken for surgical time, intra- and postoperative complications, incidence of postoperative vitreous hemorrhage, and time required to acheive best visual acuity during postoperative period. All patients were followed for a minimum 3 months following surgery.
31 cases were reviewed: 16 underwent 20-gauge PPV and 15 underwent 25-gauge PPV. Gender and age distribution were comparable in both study groups. Patients had a mean of 4.9 months post-operative follow-up. All underwent uneventful pars plana vitrectomy and endophotocoagulation. 5/16 and 7/15 patients were pseudophakic in the 20- and 25-gauge groups respectively; the remaining patients had some degree of cataract. Pre-operative visual acuity distribution for the 20 and 25-gauge cohort were as follows: range 20/20-20/100 (2, 2 cases); range 20/150 - 20/400 (5, 3 cases); range CF - LP (9, 10 cases). Three month post-operative visual acuity range was correspondingly distributed: range 20/20-20/100 (10, 9 cases); range 20/150 - 20/400 (3, 5 cases); range CF - LP (3, 1 cases). The mean overall best postoperative visual acuity was 20/40 in both groups, achieved at a mean 2.8 months in the 20-gauge group and 3.1 months in the 25-gauge group. Average intraocular pressure (IOP) on the first postoperative day was 19.3 mmHg in the 20-gauge group, 15.2 mmHg in the 25-gauge group (p = 0.04); IOP for the remaining postoperative course were similar. Residual or recurrent vitreous hemorrhage was noted in 2/16 cases in the 20-gauge, and 4/15 cases in the 25-gauge cohort. No significant complications (retinal or choroidal detachment, hypotony, endophthalmitis, cataract progression) were noted in either group.
Twenty and twenty five-gauge pars plana vitrectomy for uncomplicated diabetic vitreous hemorrhage yield similar outcomes with respect to the rate and degree of visual acuity improvement.
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